Fall 2014 Internships

1. Fall 2014 Internships

2. Info packet & required forms are on my website: • www.wou.edu/~robertsjl, then click on Internships link

3. Once you identify a site – it needs to be approved by me. • Complete Forms A, B & C • Salem Hospital and Samaritan Health Services do NOT need Form A – everyone else does! • TYPED except for signatures • Handwritten forms will NOT be accepted • Incomplete forms – 5 points will be deducted from final grade for each incomplete form. • Completed forms are due at next meeting.

4. Form A – Master Agreement This agreement is entered into this ___ day of ___ 20__ (“Effective Date” between Western Oregon University (WOU), an Oregon non-profit cooperation and education institution (WOU), and ____ (The “Experience Provider”) located at _____. For Experience Provider: For WOU: Name: Supervisor’s name Name: Janet Roberts Address: Address: 345 N. Monmouth Ave Telephone: Telephone: (503) 838-8446 Email: Email: robertsjl@wou.edu • Make sure ALL blanks are filled in • The Experience Provider = the name of the company where you will be interning.

5. Form A – Master Agreement page 2 Experience Provider: Western Oregon University: By: (Signature) By: I will sign Name: Print supervisor’s name Name: I will print my name Date:

6. Form B – Student Agreement Student Name: Your name Internship Start Date: 9/29/2014 End Date: 12/5/2014 Department and Course Number: Either HE419 or PE419 Quarter Enrolled: Fall Year: 2014 Credit Hours: 4 Internship Site (“Experience Provider”): Internship Company Name Complete Internship Address: Street #, Street, City, State, Zip Site Supervisor: Supervisor’s first and last name Phone: Supervisor’s phone# Email: Supervisor’s email

7. Form C - Objectives • Fill out the top of the form • Do NOT hand forms to your site supervisor to fill out! • Objectives need to be TYPED and in correct format (see instructions) • You will need to meet with your site supervisor before you start your internship to determine objectives.

8. Forms • Experience Provider = Internship Site • On form A; for WOU = my name / contact info • KEEP a copy of form C for your records.

9. Upcoming Meetings • Meetings are MANDATORY!! • Tuesday, Sept 30th, 4pm, location to be determined • Midterm check-in – individual meeting • Wednesday, December 10th, 12noon, location to be determined

10. Check WOU email regularly • HE419 – CRN 11226 – 8 credits – A-F • PE419 – CRN 11080 – 4 credits – A-F